I N T H E SUPR EM E C O UR T O F M I SS I SS I PPI NO. 2 0 0 6 - CA- 0 0 2 5 2 - S CT CH ARLEA N TR OU

PE
v.
J AM ES Mc AU LEY, M . D. , NO RTH

M I SS I SS I PPI M ED ICAL CENTER, I

NC . , N OR TH

M I SS I SS I PPI H EALTH SERV

I CES, I

NC . , AN

D N OR TH M I S S I S S I PP I S URGICAL CENTER, I NC.
D A T E O F JU D G M E N T : 01/ 23/ 2006 T R IA L JU D G E : H O N
. T H O M A S J. G A R D N E R , III COURT F ROM W HI CH APP EAL ED: LE E COUNTY CI RCUI T COURT ATTO RN EYS FOR A PP ELLAN T: J AM ES H. AR NO LD J OHN NI E E
. W ALL S , J R. J I M DA VI S HU LL AT T OR NE YS F OR AP P E L L E E S : J ANE L L E M AR I E L OW RE Y RO BE RT K. UP CH UR CH J OH N G
. W HEELER W I LLI AM DA NI EL PRES TAG E NATURE OF THE CAS E: CI VI L - M EDI CAL M ALP RACTI CE D I SPO SI T I O N : A FFIRM E D - 05/ 10/ 2007 M OT I ON F OR RE HE AR I NG F I L E D: M ANDAT E I S S UE D:
B E F O R E SM I T H , C . J. , C A R L SO N A N D D I C K I N SO N , JJ. CAR LS ON , J UST I CE, FOR TH E COU RT: ¶1. Fr om the tr i al court ’ s r ef us al t o acc ept the pl ai nt i f f’ s expert m edi cal w i tnes s , gr antof a di r ect ed ver di ctagai ns tthe pl ai nt i f f , and ent ry of a f

i nal j udgm enti n f

avorof the medi cal p ro v id e rs in th is m e d ica l m a lp ra c tice c a se , the p lain tiff , C h a rle a n T ro u p e (B ra d ley ), ap p e a ls

### Troupe ’s la st nam e at t he tim e of

tria l wa s Bradl ey. 1 

### A neuro-ot olaryngol ogis t i s a physi ci an who ha s c ompl et ed a fiv e- year m inimum 2 

### re si denc y training program in otol ar yngology ( ear, nose , an d throat surger y) f oll owed by adv ancedfellow ship trainin g ino tolo gy/neuro-o tolo gy . A n euro -oto laryn go log ist qu ite oft en wi llre stri ct

his or he r prac ti ceto proble ms re lating to t he e ar . The CT Sc an and the MRI s howed the a nat omy of

Troupe ’s ear t o be in a nor ma l 3 

### posi ti on. Dr . Mc Aule y saw what he be li eve d to be a tum or whi lelooking int o Troupe ’s ear during the p hy sical examin ation
. Troupe ’s surger

y was conduc te d in NMMC’s s urge ry uni t, North Mis si ss ippi 4 

### Surgi ca l Uni t, Inc
. 2 to u s. F in d in g n o re v e rsib le e rro r, w e a ffirm th e fin a l ju d g m e n t en ter e d b y th e L e e C o u n ty C ir c u it C o u rt . F ACT S AND P ROCE ED I NGS I N T HE T RI AL COURT ¶2. C har l ean Tr oupe B r adl ey ( T r oupe) w as ref err ed t o D r . J ames M cA ul ey, a neur o- 1
o to lar y n g o lo g ist, b y D r. H a ro ld H u d so n , w h o w a s D r. M c A u ley ’s p a rtn e r. T h e re fe rra l to 2 D r . M cA ul ey w as f

orthe purpos e of

r evi ew i ng w hatD r . H uds on s us pect ed w as a gl om us tym pani cum, ora beni gn tum or , i n T r oupe’ s l ef tm i ddl e ea r . D r . H uds on had per f or m ed a p h y s i c a l e x a mi n a t i o n o f Tr o u p e a n d h a d o r d e r e d a Co mp u t e r i z e d To mo g r a p h y S c a n ( CT Scan)
. D r . M c A ul e y the n c on du c t e d a p hy s i c a l e xa mi na t i on o f Tr ou pe ’ s e a ra nd or der ed M agnet i c R es onance Imagi ng (M R I ) t o be done. B as ed upon the i nf or m at i on pr ovi ded by the C T s can a nd M R I , D r . M cA ul ey conc l uded t hatT r oupe di d i ndeed ha ve a gl om us tym pani cum and sc hedul ed s ur gery. 3 ¶ 3
. O n M a rc h 1 , 2 0 0 1 , D r. M c A u ley p e rfo rm e d su rg e ry o n T ro u p e ’s m id d le e a r a t N o rth M i ssi s s i ppi M edi cal C ent er( N M M C ) i n T upel o. D ur i ng the s ur gery, D r . M cA ul ey made 4

### Dr. McAul ey t es ti fi ed that he ha d neve r seeno r read a bout a doubly anoma lous 5 

### carotid art er

y. Hefurthe r t es ti fi ed that, in his t ra ining, ba se d upon his physi ca l e xam inati on of Troupe’ s e ar , “ theonly t hing i t c ould beis a gl omus tym pani cum .” NMHS is a uni t of

NMMC. 6 

### 3 cont actw i th w hathe thoughtw as a tum or . I ns t ead, w hatw as thoughtt o be a tum ortur ned
o u tt o b e a d o u b l y a n o ma l o u s c a r o t i d a r t e ry , wh i c h h e c o u l d n o ts e e o n th e CT s c a n a n d M RI 5 th a t h a d b e e n c o n d u c ted . T h e a rte ry to re , an d b e c a u s e D r. M c A u ley c o u ld n o t se a l itw ith
s t i t ches , he us ed s ur gi cal packi ng t o contr ol the bl eedi ng. ¶4. I m m edi at el y af

t er s ur gery, D r . R obert B ecke r ( D r . B ecke r ) , N M M C ’ s i nt ervent i onal
r adi ol ogi s t , t hen per f

or m ed anotherC T Scan and a n art er i ogr am on T r oupe’ s ear . D r . B ecke r confi rm ed t hatD r . M cA ul ey di d notl i f ta tum or , buti n f

actl i f t ed Troupe ’ s car ot i d art ery. B eca us e D r . Bec ke rwas g oi ng t o be o uto f t own the n e xtd a y, Dr
. M c A ul e y a rr a ng e d f or Tr o u p e t o b e t r a n s f

e r r e d t o t h e Un i v e r s i ty o f Al a b a ma Ho s p i t a l i n Bi r mi n g h a m, Al a b a ma (U A B H ), fo r tre a tm e n t, b e c a u se h e w a n ted to m a k e su re a n in ter v e n tio n a l ra d io lo g ist w o u ld be ava i l abl e i f

neede d. T r oupe w as pr es cr i bed nar cot i cs f orpai n by D r . E thel B eas l ey at No r th M i s s i s s i p p i He a l th S e r v i c e s , I n c . ( NM HS ) , p r i o rt o b e i n g tr a n s p o r t e d f r o m N M M C 6 t o UAB H. ¶5. U po n her return h om e fr om U A B H , T r oupe w as s entt o M i s s i ssi pp i M et ho dis t R ehabi l i t at i on C ent er( M M R C ) i n J acks on f orther apy. W hi l e atM M R C , T r oupe deve l oped
a movem entdi s or dert hatphysi ci ans det erm i ned w as notdue t o the i nj ury t o herart ery but
w as i ns t ead due t o a ps ychol ogi cal pr obl em. T he r ecor d r evea l ed the medi cal opi ni on w as

### MMRCA’s motion s tate s: “Thehospi ta l whe rePlaintif f r ec ei ved r eha

bilitation 7 

### treatm ent is owned and operat ed by TheMis si ss ippiMethodis t Hos pit aland Re habi li tati on Center, Inc. (E x h ib it “ C ” ). 

### Mississip pi Meth od ist R ehab ilitationCenter Auxiliary , Inc. is a s eparatecor

porati on for

me d for thepurpos e of

provid ing financ ia l and spiri tua l s upport to t he hos pit aland i ts patie nts . ( Exhibi t “ D”) . Mi ss is sippi Me thodi st Reha bil it ation Ce nte r Auxil iary, Inc ., does not own or operat e the hos pit alto whi ch Pl ainti ff was admitte d on March15 , 20 01 .” Tro up e f il edaM o tionto A mendthe C omp laint o n Ju ly 3 0, 2 00 1, to am end the n am eof the de fe ndant , MMRCA, to Mi ss is sippi Me thodi st Reha bil it ation Ce nte r, Inc. In Judg e Y erger’s orde r of Febr uar y 14, 2002, theHinds County Circ uit Court 8 

### re taine d thecl ai ms a gainst Mi ss is sippi Methodis t Reha bil it ation Cent er

Auxi li ar y, Inc. and Mis si ss ippiMethodis t Re habi li tati on Cent er , Inc. , and trans fe rr ed the c laims ag ainst Dr
. McAul ey and NMMC t o the Circui t Court of Le e County, whi ch ultimate ly e nte re d a f ina l 4 thatT r oupe’ s “patt ern of appar entabnorm al m ov em ent s i s notcompat i bl e w i th any
neur ol ogi c di s or der , ” buti ns t ead, “ i m pr ovementw i th di s tr act i on i s a s tr ong i ndi cat i on t hat th e s e a re p s y c h o lo g ic a lly a n d n o t n e u ro lo g ic a lly m e d ia te d .” ¶ 6
. On J u n e 4 , 2 0 0 1 , Tr o u p e f i l e d h e r o r i g i n a l c o mp l a i n t a g a i n s t Dr
. M c Au l e y , NM M C, M i s s i s s i ppi M ethodi stR ehabi l i t at i on C ent erA uxi l i ary, I nc. ( M M R C A ) , and “J ohn D oe Per s on( s ) ” and “ J ohn D oe Ent i ty( i es ) , ” i n the C i r cui tC our tf orthe Fi r s tJ udi ci al D i s tr i ctof H in d s C o u n ty . O n Ju ly 6 , 2 0 0 1 , M M R C A filed a m o tio n to d ism iss b a se d o n a fa ilu re to
s t at e a c l ai m and f

ai l ur e t o s ue the corr ecten t i t y. O n J ul y 12, 2001, D r . M cA ul ey and 7 N M M C f

i l ed a j oi ntM ot i on f

orC hange of

V enue, or i n the A l t ernat i ve, t o Severand C hange V e n u e . O n F eb rua ry 1 4 , 2 0 0 2 , the H ind s C o u n ty C ir cu itC o u rt , Ju d g e S w an Y erg er, pr es i di ng, ent er ed an O r derSever i ng C l ai m s and Tra ns f err i ng V enue, ther eby tr ans f err i ng T r oupe’ s s ever ed cl ai m s agai ns tD r . M cA ul ey and N M M C to the C i r cui tC our tof L ee C ounty. 8

### jud gment onthe claims assertedagain st Dr. M cAu ley, N MM C, an d th e oth er d efen dants

adde d af te r the tra nsf er to Le e County. Thus, Mi ss is sippi Methodis t Re habi li tati on Cent er Auxiliary , Inc., an d M ississipp i Meth od ist Reh abilitatio n C enter, Inc., are not p arties to th is app eal. Bec auseNMHS and NMSC areunit s of NMMC and we redef

ende d at tria l a s one 9 

### entit y by thesameattor

ney, we wi llre fe r t o the sedef endants col le ctive ly a s NMMC. Dr. B easley’s first n ame is actuallyEth el. 10 

### 5 ¶7. I n herf

i r s tamended compl ai ntf i l ed i n the Lee C ounty C i r cui tC our ton D ece m ber 23, 2 0 0 2 , T rou p e a d d ed as p arty-d efe n d an ts N o rth M issi ssipp i H ea lth S erv ices, Inc. (N M H S ), N orth M i s s i s s i pp i Sur gi c a l Cent e r , I nc . ( N M SC) , D r . Robe r tBec ke r , a nd D r . Et ha S. 9 B ea sley as d efe n d an ts. H o w ev er, the tri al j u d g e e v en tually en tered o rde rs dism issi n g D r.

10 B ecke rand D r . B eas l ey, w i th pr ej udi ce. ¶8. O n Sept ember2 6, 2 00 5, N M M C , N M H S , an d N M S C fi l ed a M ot i on t o St r i ke P la in tif f’ s D e s ig n a tio n o f E x p e rt W itn e s s e s . T h is m o tio n , a s s e rt e d , i nt eral i a, that T rou p e’s

“ f ormal d e s i gn a t i on o f

tr i a l e xp e r t s , d a t e d Se pt e mber6 , 2 00 5, was s ub mi t t e d l e s s tha n t he
s i xty ( 60) days r equi r ed by R ul e 4. 04 of the U ni f or m C i r cui tand C ounty R ul es , ” i nas m uch as th e tri al w as sc h ed u led to b eg in o n O ctob er 3 1 , 2 0 0 5
. O n S ep tem b er 2 8 , 2 0 0 5 , D r. M c A u ley fi le d a J o in d e r o f th e D e fe n d a n t, Ja m e s M c A u ley , M .D ., in M o tio n o f N o rth M i ssi ssi pp i M edical C enter , Inc. , etal
. , t o S tri ke P l ai nti ff’s D esi gn at i on of E xp ertW i tnesses. W e fi nd no thing i n the r ecord co ncerni ng the tr i al cou rt ’s dis po si t i on of these m oti on s. ¶ 9
. O n O c to b e r 3 1 , 2 0 0 5 , an d N o v e m b e r 1 , 2 0 0 5 , a ju ry tri a l w a s c o n d u c ted in th e C irc u it C ourto f L ee C ounty, J udge Thom as J
. G ar dner , I I I , pr es i di ng. T r oupe comm ence d her

### 6

pr es ent at i on of

the evi dence by cal l i ng D r . M cA ul ey as a n a dver s e w i tnes s . T r oup e t hen
ca ll ed D r. C h arles E
. R aw li n g s to the w itn ess s tand in an effort to qu ali fy h im as a n ex p ert
w i tnes s i n the f

i el d of neur os ur gery as opposed t o ot ol aryngol ogy orneur o- ot ol aryngol ogy. ¶1 0
. D u ri n g h is vo ird ir e o f D r. R aw li n g s in an e ffort t o q u ali fy h im as a n ex p ert, T rou p e’s
a tto rn e y e lic ite d fr o m D r. R a w lin g s b e fo re th e ju ry , in tera lia , thathe w as a phys i ci an,
n e u ro su rg e o n a n d a tto rn e y ; th a t h e w a s b o a rd c e rtified in n e u ro su rg e ry , cu rre n t o n h is cont i nui ng m edi cal educa t i on, buthe w as notcur r ent l y pra ct i ci ng neur os ur gery; t hathe had a l aw de gr e e f

r om W a ke Fo r e s tUni ve r s i ty; a nd tha t , a s t o Tr ou pe ’ s l i t i ga t i on , h e had
rev iew ed h er m ed ical rec o rds fro m N M M C an d U A B H
. T rou p e’s a tt o rne y then ask ed D r. R aw l i ngs , “[ b] as ed upon yourr evi ew of [ T r oupe’ s ] r ecor ds , m edi cal r ecor ds and your
o p in io n to a re a s o n a b le d e g re e o f m e d ic a l c e rt a in ty , te ll th e ju ry w h a t h a p p e n e d to [T ro u p e ].” A tthi s poi nt , the att orneys f orD r . M cA ul ey and N M M C obj ect ed, and Troupe ’ s couns el t hen ask e d J u d g e G a rdn er to a cc ep t D r. R aw li n g s as a n ex p ert i n the s p ec ial ty o f neu rosurgery
r atherthan ot olar

yngol ogy orneur o- ot olar yngol ogy . Judg e G ardner put the jury in r ecess, and out s i de t he pr es ence of the j ury, T r oupe’ s counse l ar gued t hatD r . R aw l i ngs ’ s t es t i m ony
w as acc ept abl e bec aus e D r . R aw l i ngs had t rai ni ng i n s ur gery, and bec aus e the doct orw ho tr eat ed Troupe atU A B H w as a neur ol ogi s t . O ut s i de t he pr es ence of the j ury, Judge G ar dner
a llo w e d T ro u p e ’s c o u n se l to c o n tin u e to a ttem p t to q u a lify D r. R a w lin g s a s a n e x p e rt in
neur o- ot ol aryngol ogy, and the f ol l ow i ng ques t i oni ng occurr ed: Q
. D r . R aw l i ngs , ar e you tr ai ned i n s ur gery i n the hea d ar ea? A
. Y es.

### 7

Q
. Is i t som eti m es c o m m o n ly referred to a n eu rosu rge o n as a bra in su rge ry (si c)? A
. Iti s. Q
. O kay. A nd a r e you c om pet entt o do any type of s ur gery i nvol vi ng the ar ea of the br ai n and the i nt ernal or gans of the hea d? A
. N eur os ur gery i s thatpartof the sur gery t hatdoes pr ocedur es upon the head, the s cal p, the s kul l , the cove r i ng of the br ai n, the brai n and t he art er i es thatl ead t o t he br ai n. Q
. O kay. W oul d you be f ami l i arw i th the l ef

ti nt ernal car ot i d art ery? A
. I w oul d be. Q
. A nd the othera r t er i es c om m uni cat i ng ors urr oundi ng, r ece i vi ng bl ood off of that m ai n art ery and al l of the v essel s of t he h ead, i ncludi ng tho se in an d aro u n d the e ar? A
. Y es, si r.

. . . . Q
. D oct or , you r ead the r ecor ds , m edi cal r ecor ds conce rni ng C har l ean. H ave you ha d exper i ence , d i re ctexper i ence w i th thi ngs , cas es i nvolvi ng the ca r ot i d art ery and the mat t er s conce rni ng the vas cul ar s ys t em aboutw hi ch w e' r e her e t oday i n the ca se of C har l ean Tr oupe B r adl ey? A
. Y es . I mean the neur os ur geons ope r at e upon the car ot i d a r t ery, and the cas e t oday i s pr i m ar i l y aboutbi ops yi ng a norm al car ot i d art ery. Q
. H o w m a n y su c h c a se s h a v e y o u p e rfo rm e d o r b e e n in v o lv e d in i nv olvi ng the caroti d art ery and the it em s that w ou l d rel at e t o the case thatw e' r e her e aboutt oday? A
. It w o u ld b e h ard to p u t a nu m b er o n them , b u t do ing ca rotid endart er ect om i es and al so cl i ppi ng aneur i s m s you' r e dea l i ng w i th the ca roti d artery y o u rself. Q
. C o u ld y o u tell th e C o u rt w h a t p e rc e n tag e o f y o u r p ra c tice d e a lt w ith thattype s ur gery? A
. In tra c ra n ial p ro c e d u re s w e re a b o u t 3 0 to 4 0 p e rc e n t. [P L A IN T IF F ’S C O U N S E L ]:

M ay i tp l ease the C our t , bas ed upon D oct or R aw l i ngs ' t es t i m ony r egar di ng hi s exper i ence and tra in in g , w e a g a in o ffe r h im a s a n e x p e rt in th is cas e.

### Troupe ’s attor ney ha d argued t o JudgeGardner that t he att orne ys for

Dr. Mc Aule y 11 

### and NMMC, a s a

pre re quis it e t o arguing t

hat Dr. Rawl ings was not qua li fi ed t o te stif y as an expe rt , s hould have c onduct ed voir dire o f D r. Rawlings upon hi s be ing t ende re d as an exp ert. 8 ¶ 1 1
. In re fu sin g to ac c e p t D r. R a w lin g s a s a n e x p e rt i n neur o- ot olar yngol ogy w her e he w as ten d e re d a s a n e x p e rt i n n eurosurg ery , J u d g e G a rd n e r s ta te d , in tera lia : T h e C o u rt is o f th e o p in io n th a t th e b u rd e n im p o se d o n th e P lain tiff in th is c a se is to e sta b lish a s to the d e fe n d a n t do c to r in h is p a rticu lar field o f sp e c ialty a sta n d a rd o f c a re w h ic h h e o w e d to th e P lain tiff in th is c a se a n d to demons tr a t e –a nd tha ts t a nd a r d of c a r e i s b e c a us e o f

wher e h e i s i n t he d i s c i p l i n e th a th e i s tr a i n e d i n . I t 's n o ta g e n e r a l p r a c t i t i o n e r 's s t a n d a r d , i t 's h ig h e r th a n th a t, an d th e v o ir d ire o r q u a lifica tio n , th e a ttem p t to q u a lify th is w itn e ss d o e sn ' t ev e n to u c h o n th a t. F u rth er, th ere m u st be so m e sh o w ing o f so m e v iolati o n o f tha t st an d ard o f ca re im p o se d o n th e d o c to r w ith in th e sp e c ialty th a t h e p u rsu e s a n d th a t th a t in s o m e w a y re s u lte d in th e d a m a g e s o r i n ju ri e s s u s ta in e d b y th e P la in tif f. T o s ay t hata neur os ur geon know s i ntui t i vel y w hatthe s t andar d of car e i s as t o D r . M cA ul ey ori n any o t her di s ci pl i ne w i thi n the pr act i ce of m edi ci ne p re su p p o se s a w h o le lo t o f in fo rm a tio n th a t' s n o t m a d e c lea r h e re b y h is qual i f i cat i on and voi rdi r e oryourques t i ons di r ect ed t o hi m . A nd as t o the req u ir em e n t tha t th e D efe n d an ts pa rt ici p ate in q u ali fyin g h im b y v o ird ir e e x a m in a tio n , I th in k th a t' s lu d icr o u s.[ ] T h e y ' re c e rta in ly w ith in th e ir rig h t to 11 s t and on the qual i f

i cat i ons t ender ed and t o notexpand on thati nadvert ent l y or g iv in g a n y fu rth e r o p p o rtu n ity if th e y e lec t to d o th a t. T he o pini on of the C ou rti s that this w i tness i s not com petentt o tes t i fy agai nst D r . M cA ul ey i n thi s cas e s i m pl y beca us e he ha s notes t abli shed by vi r tue of tra in in g o r o th e rw ise th a t h e k n o w s th e s tan d a rd o f c a re , tha t h e ' s fa m ili a r w ith thatand ca n t es t i f

y abouthow , i f

any, i n any w ay thats t andar d w as br eac hed and the ca us al connec t i on. N ow , the mat t er s havi ng t o do w i th neur os ur gery, I don' thave a ny ques t i on but thathe i s a compet entw i tnes s . I f you' r e goi ng t o ques t i on hi m conce rni ng caus at i on, vi ol at i on of

the s t and ar d orthe s t andar d i t s el f , I thi nk he i s not q u a lified to tes tify a b o u t th a t.

### 9

N o w , if y o u w ish to m a k e a re c o rd , y o u m a y d o so b y p ro ffe r o r b y a sk in g h im qu est i on s. ¶1 2
. A c c e p tin g th is inv it ati o n fr o m th e tr ial ju d g e , T ro u p e ’s a tto rn e y c o n tin u e d h is q u e stio n in g o f D r. R a w lin g s (a g a in , o u ts id e th e p re se n c e o f th e ju ry ), in o rd e r to m a k e h is pr of f erf orthe r ecor d. D ur i ng thi s prof f er , D r . R aw l i ngs t es t i f

i ed, t o a r eas onabl e degr ee of
m e d ic a l c e rt a in ty , in tera lia : thatw hen Troupe pr es ent ed t o D r . M cA ul ey, s he compl ai ned of di zzi nes s and dec r eas ed hear i ng i n he rl ef te ar ; thatthe C T s can a nd M R I per f or m ed under th e su p e rv isio n o f D r. H u d so n o r D r. M c A u ley w e re n o rm a l; th a t D r. M c A u ley e v e n tu a lly di s cover ed a mas s behi nd T r oupe’ s l ef tear drum , w hi ch he be l i eved t o be a beni gn vas cul ar tum or ; thatbas ed on thi s di agnos i s , D r . M cA ul ey per f or m ed s ur gery, r es ul t i ng i n the t ear i ng
w h ich d a m ag ed T rou p e’s leftinterna l caro ti d artery, ne ce ssit ati n g an o cc lusion o f th e left
car ot i d art ery; t hatdur i ng herhos pi t al i zat i on, T r oupe had s ever al epi s odes of hypot ens i on
r es ul t i ng i n a tr emor di s or der ; that t her e w as a br eac h of the s t andar d of

car e i n t he i nappr opr i at e admi ni s tr at i on of m orphi ne atN M M C pr i ort o T r oupe’ s tr ans por t at i on f r om N M M C t o U A B H ; that th e resu lt ing hy po xia “m ore than l i kely dam aged or atl east phys i ol ogi cal l y change d, dama ged her deep brai n st ructur es thats ubs erve movem ent , i n other
w or ds , coor di nat i on; ” thatD r . M cA ul ey s peci f i cal l y br eac hed the s t andar d of car e t o w hi ch T rou p e w as e n ti tl ed “[b]y n o t ru lin g o u t th e p rese n ce o f an ab erran t i n terna l caro ti d artery
a n d b y u p o n th e su rg e ry lac e ra tin g o r b io p sy in g o r te a rin g th e a b e rra n t in ter n a l ca ro tid
art ery; ” thatD r . M cA ul ey br eac hed the s t andar d of car e by notrul i ng outthe pr es ence of an
an eu ri sm o r an ab erran t art ery u p o n h is disco v ery o f th e re d d ish- bluish m ass b eh ind T rou p e’s

### 10

l ef tear drum ; and, thatT r oupe’ s ul t i m at e i nj ury caus ed by D r . M cA ul ey’ s br eac h of the
s t andar d of

car e r es ul t ed i n T r oupe’ s m ovemen td i sorder
. T he f ol l ow i ng col l oquy t hen
occu rr ed b et w een T roupe’s coun sel and D r. R aw l i ng s: Q
. D o c to r, as a n e u ro su rg e o n w o u ld y o u b e fa m ili a r w ith th e d a m a g e s to herdeep br ai n s tructur es ? I s thata partof yourtr ai ni ng? A
. Iti s. Q
. O k a y . D o c to r, to a re a so n a b le d e g re e o f m e d ica l c e rta in ty c a n h y p o x ia cause v ari ou s typ es of m ov em ent di sorder s? A
. I tcan. Q
. A nd D oct or, b as ed upon yourm edi cal know l edge a nd tr ai ni ng t o a re a so n a b le d e g re e o f m e d ic a l c e rt a in ty c a n h y p o x ia c a u s e p ro g re s s iv e ly deter i orat i ng m ov em ent di sorder s? A
. Itcou l d, yes. Q. Ok a y . An d wo u l d th a te x p l a i n why M r s . Tr o u p e h a d e p i s o d e s o f s o me cl ar i t y i n herm ovementdi s or deraf t ert aki ng M ys ol i ne and then u lti m a tely the co n d iti o n p ro g re ss in g to a p o in t w h e re M y so lin e b y itse lf w oul d notal l evi at e hercondi t i on? A
. It ' s one p ossi bil i ty, yes. Q
. O ka y. D oc t or , a r e yo u s a yi ng t o a r e a s on a bl e de gr e e of medi c al cert ai nty thatD r . M cA ul ey and the N or th M i s s i s s i ppi M edi cal C ent er vi ol at ed the s t andar d of m edi cal car e thatw as due M r s . T r oupe i n her tre a tm e n t? A
. In m y o pini on , yes. ¶13
. U p on D r. R aw l i ng s being t end ered b y T rou p e’s a tt o rne y , the a tt o rne y s for D r. M cA uley a nd N M M C conduct ed thei rvoi rdi r e of D r . R aw l i ngs f

orthe r ecor d. D ur i ng d e fe n se c o u n se ls’ v o ir d ire , itw a s re v e a led : th a t D r. R a w lin g s la st p e rfo rm e d su rg e ry in D ec em b er, 19 9 9 ; th at i n M arc h , 2 0 0 1 , w h en T ro u p e p rese n ted to D r. M cA u ley, D r. R aw l i ngs , a neur o- s ur geon, w as a f ul l
- t i m e l aw stud ent, and as of J ul y, 2001, he had
r el i nqui s hed al l s t af

f pr i vi l eges athos pi t al s ; thati n 2002, D r . R aw l i ngs gr aduat ed f r om l aw
s chool and w as admi t t ed t o pr act i ce l aw i n N or th C ar ol i na, w her e he s peci al i zed i n m edi cal

### 11

negl i ge nc e c a s e s ; tha tD r . Raw l i ng s ha d n e ve rpu r s ue d a n o t ol a ryn go l og y r e s i de nc y or f el l ow s hi p; thatD r . R aw l i ngs w as aw ar e thatD r . M cA ul ey had a f el l ow s hi p i n neur oo t o l a ry n g o l o g y ; a n d , th a twhi l e o n t h e me d i c a l s t a f f a tF o r s y th Ho s p i t a l i n W i n s t o n - S a l e m, N orth C arol i na, D r. R aw l i ng s never had pri vil eges t o p erf orm m i dd l e ear s urgery, becau se
s uch pr i vi l eges w er e r es erved f orphys i ci ans w ho s peci al i zed i n ot ol aryngol ogy. ¶14. Fi nal l y, up on further qu est i on i ng b y T r oupe’ s att orney, D r . R aw l i ngs t es t i f i ed as fol l ow s: Q
. D oct or , t o a r eas onabl e degr ee of m edi cal cert ai nty i s i tever appr opr i at e f

ora phys i ci an doi ng t he t ype oper at i on thatD r . M cA ul ey o r a n y o th e r p h y sic ian w a s d o in g o r p u rp o rte d to d o in h is re c o rd s to cutthe ca r ot i d art ery? A
. N o. Q
. I s thatal w ays a br eac h of the s t andar d of

car e? A
. Iti s.

. . . . Q
. D octor , w oul d i tbe pos s i bl e f ora neur os ur geon t o gi ve an opi ni on as t o t he l ace r at i on of

a ca r ot i d art ery? [O b je c tio n b y o p p o s in g c o u n s e l.] Q
. R egar dl es s of

w hetherornoti tw as done by an EN T s peci al i s tor perhaps even a doct orw i th yours peci al ty? [O b je c tio n o v e rr u le d .] A
. Y es. ¶15. A gai n, J udge G ar dner r ef us ed t o decl ar e D r . R aw l i ngs as an expert t o of f eropi ni ons bef or e the j ury a s t o D r . M cA ul ey’ s a l l eged br eac h of the s t andar d of

car e ow ed t o T r oupe,

### Eff ec tive De ce mbe r 9, 2004, a s to tria l c ourt orde rs ent er ed f

rom and a ft er March 12 

### 1, 2005, theprovi si ons of Miss. R . App. P. 5( a) and 5(b) we ream ende d to e liminat e the re quirem ent

of s ee king t

ri alcourt ce rtif

ic ation of an int erloc utor

y appea l to thi s Cour

t. Sinc e thetria l of

today’s ca seocc urr ed on Oc tobe r 31 and Novem ber 1, 2005, Troupewas not requ ired to seek trial co urt certificatio n o f an interlocutoryapp eal to th is Co urt. Inanyevent, Tro up e nev er sou ght relief from th is Co urt v ia an interlocutoryapp eal. 12 w h e re u p o n th e a tto rn e y fo r T ro u p e th e n re q u e ste d J u d g e G a rd n e r to c e rtify th is is su e to th is C o u rt v ia a n in ter lo c u to ry a p p e a l, an d Ju d g e G a rd n e r d e n ied th is re q u e st. 12 ¶16. U pon J udge G ar dner ’ s di s al l ow ance of D r . R aw l i ngs ’ s t es t i m ony, T r oupe’ s couns el
r es t ed the pl ai nt i f

f’ s c as e- i n- chi ef

. T he att orneys f

orD r . M cA ul ey and N M M C then moved f ora di r ect ed ver di ct , w hi ch J udge G ar dnergr ant ed. C ons i s t entw i th the gr antof a di r ect ed
ver di ct , J udge G ar dners ubs equent l y ent er ed a f i nal j udgm enti n f

avorof D r . M cA ul ey and N M M C on N ovember10, 2005. O n N ovember14, 2005, T r oupe f i l ed a mot i on r eques t i ng the tr i al cou rtt o recon si der i t s ruli ng prohibi t i ng D r. R aw l i ng s t o t est i fy as an exp ertw i tness pu rs uan tt o M i ss. R
. E vid. 7 02 , an d al so requ est i ng a new tri al
. Judg e G ardner denied t hese pos t - tr i al m ot i ons by or derent er ed on J anuary 23, 2006. T r oupe t i m el y f i l ed hernot i ce of appea l on February 6, 2006. DI S CU S S I ON ¶17. T her e i s butone cr i t i cal i s s ue f orthi s Courtt o deci de t oday. C har l ean Tr oupe phr as es the i s s ue as f

ol l ow s : “The t r i al courterr ed i n r ef us i ng t o acc eptD r . R aw l i ngs as an expe r ton the s tand ard o f ca re o n the b asis that a n eu rosu rge o n ca n n o t t esti fy a s to the stan d ard o f ca re
o w e d b y a n e u ro -o to lar y n g o lo g ist.” N M M C a ss e rts th a t “[t]h e trial c o u rt h e re in ac ted w e ll
w ith in its d isc re tio n in e x c lu d in g th e o p in io n te stim o n y o f M s. T ro u p e ’s te n d e re d e x p e rt,

### 13

C har l es E
. R aw l i ngs , M
. D
. , af t erfi ndi ng t hatD r . R aw l i ngs fa i l ed t o demonstr at e educ at i on, tr ai ni ng, orexper i ence i n the medi cal s peci al t y of t he heal th car e pr ovi derdef endant s or know l edge of

the appl i cabl e st andar ds of ca r e. ” Fi nal l y, D r . M cA ul ey pr es ent s t o us thatt he tr i al courtappropr i at el y f ound t hatD r . R aw l i ngs w as as a mat t erof l aw i ncapa bl e, as “a
n eu rosu rge o n an d law y er,” o f offering an ex p ert op inion as to the p rop er sta n d ard o f ca re appl i cabl e t o a neur o- ot ol aryngol ogi s t , and thatthe tr i al court( 1) pr operl y excl uded the test im o n y o f D r. R aw li n g s, an d thu s co rrectl y g ran ted a d ir ec ted v erd ict in fav o r of D r. M cA ul ey; and ( 2) pr oper l y r ef us ed t o acce ptD r . R aw l i ngs as an expe r t , butthatthi s r ef us al on the partof

the tr i al court“w as notbas ed upon [ D r . Raw l i ngs ] be i ng a ne ur os ur geon, but
w a s b a s e d u p o n D r. R a w lin g s n o t k n o w in g th e s ta n d a rd o f c a re a p p lic a b le to D r. M c A u le y .” ¶18. W e thus r ephr as e the s ol e i s s ue bef or e us f orcl ar i ty i n di s cus s i on. W H ET H ER TH E T R I A L C O UR T ER RE D I N R EFU SI NG TO AC CE PT DR. RAW LI NGS , TE NDE RE D AS AN E XPERT I N NE UROS URGE RY, TO T ES TI F Y AS TO T HE S TANDA RD OF CARE OW ED BY A NEURO - OTO LARYN GO LOG I S T. ¶19. “The s t andar d of r evi ew f or the admi s s i on or s uppr es s i on of evi dence i n M i s s i s s i ppi i s abus e of

di s cr et i on. ” P oo le v. A va ra , 908 So. 2d 716, 721 ( M i s s . 2005) ( ci t i ng Miss. T ran s. Com m ’n v. McL em ore , 86 3 S o. 2d 31, 34 ( M i s s . 2003) )
. “The t r i al j udge has t he
s ound di s cr et i on t o admi torr ef us e expe r tt es t i m ony; a n a bus e of di s cr et i on s t andar d m eans the j udge’ s deci s i on w i l l s t and unl es s the di s cr et i on he us ed i s found t o be arbi tr ary and cl ear l y err oneous . ” I

d. W h e n c o n sid e rin g a tr ia l co u rt’s g ra n t o f a d ire c ted v e rd ict, th is C o u rt ’s s ta n d a rd o f re v ie w is d e n o v o . W hite v. Stew m an , 93 2 S o . 2 d 2 7 , 3 2 (M iss. 2 0 0 6 ).

### 14

¶20
. T roupe argues that the tri al cou rt ref used t o accep t D r. R aw l i ng s as an exp ertw i tness
s i m pl y beca us e he w as a neur os ur geon r atherthan an ot ol aryngol og i s torneur oo to lar y n g o lo g ist. H o w e v e r, D r. M c A u le y a n d N M M C a rg u e th a t th e trial c o u rt c o rre c tly
re fu se d to a c c e p t D r. R a w lin g s a s a n e x p e rt w itn e ss b e c a u se h e lac k e d th e re q u isite k n o w led g e to tes tify as to th e sta n d a rd o f c a re o w e d b y a n e u ro -o to lar y n g o lo g ist w her e he
w as t end ered on l

y as an experti n n eurosurg ery . ¶21
. M i ss. R
. E vid. 70 2 (am end ed 2 00 3) st at es: I f s ci ent i f i c, t echni cal , orothers peci al i zed kn ow l edge w i l l as s i s tthe tr i erof factt o u nd erstan d the evi den ce or t o d et erm i ne a facti n is sue, a w i tness qual i f i ed as an expe r tby know l edge, ski l l , exper i ence , t r ai ni ng, oreduca t i on, m ay t es t i f

y ther et o i n the f

or m of an opi ni on orotherw i s e, i f ( 1) the t es t i m ony is b a se d o n su ffic ien t fa c ts o r d a ta, (2 ) th e tes tim o n y is th e p ro d u c t o f re liab le pr i nci pl es and met hods , and ( 3) the w i tnes s has appl i ed t he pri nci pl es and m ethods r el i abl y t o t he f act s of the ca s e. ¶22
. T his C ou rtrecent l y h ad an occasi on t o o nce ag ai n ad dress the is sue of exp ert w i tness t es t i m ony i n a medi cal m al pr act i ce s ett i ng. I n Cheeks v. B i o-Medical A ppli cati ons, I

nc. , 908 So. 2d 117 ( M i s s . 2005) , thi s C our ts t at ed: T o pr es enta pr i m a f

aci e ca s e of

m edi cal m al pr act i ce, a pl ai nti ff , ( 1) af t er e sta b lish in g th e d o c to r-p a tien t re latio n sh ip a n d its a tten d a n t d u ty , is g e n e ra lly r equi red t o pr es entexpertt es t i m ony ( 2) i dent i f yi ng and art i cul at i ng the r equi s i t e s t andar d of

car e; and ( 3) es t abl i s hi ng thatthe def endantphys i ci an fai l ed to con form t o the stan d ard o f car e. In addit i on , (4) the p l ai nti ff m ust pr ove the phys i ci an’ s noncompl i ance w i th the s t andar d of car e ca us ed the plai nti ff’s i njury, as w el l as prov i ng (5) the ex t ent of the p l ai nti ff’s dam ages. Mc Ca ffr e y v. P u c k e tt , 784 So. 2d 197, 206 ( M i s s . 2001) ( ci t i ng L adnerv. Ca m p b e ll , 5 1 5 S o . 2 d 8 8 2 , 8 8 7 -8 8 (M iss . 1 9 8 7 )). A p h y s ic ia n w h o is su ffi cien tl y “fa m il iar w ith the s tand ard s o f [a m ed ical] sp ec ial ty, [ m ay test if y as an exper t , even] t hough he [ does ] notpra ct i ce the spe ci al ty hi m s el f
. ” W est v. S a n de rs Clin i c f

o rW o me n , P. A. , 6 6 1 S o . 2 d 7 1 4 , 7 1 8 -19 (M iss. 1 9 9 5 ). “It i s ourgener al rul e thati n a medi cal m al pr act i ce a ct i on negl i gence cannotbe

### 15

estab li sh ed w ith o u t m ed ical test im o n y th at th e d efe n d an t f ail ed to u se o rdin ary s ki l l and ca r e. ” B ro o ks v . R o b e rts , 882 So. 2d 229, 232 (M i s s . 2004) ( ci t i ng S h e ffie ld v. G o o dw in , 7 4 0 S o . 2 d 8 5 4 , 8 5 8 (M iss. 1 9 9 9 )). I d. at120. T hus , thi s C our tm akes i tcl earthatther e i s no pers e rul e thatD r . R aw l i ngs had t o be a neur o- ot ol aryngol ogi s ti n or dert o be qual i f i ed t o t es t i f

y as an expe r ti n the ca s e s ub j udi ce . H o w e v e r, D r. R a w lin g s h a d to d e m o n stra te th a t h e w a s s u ffic ien tly “ fa m ilia r w ith the s t a nd a r ds o f

” n e ur o- ot ol a r yn go l og y by k no w l e dg e , s ki l l , e xp e r i e nc e , tr a i ni ng , or educa t i on i n acc or dance w i th M i s s . R
. E vi d. 702. ¶ 2 3
. T h e re fo re , it is c ru c ia l t o u n d e rsta n d th e fa c tu a l b a sis fo r th is C o u rt’s d e c isio n in Cheeks , i nvol vi ng a m edi cal negl i gence cl ai m due t o the dea th of a di al ys i s pat i entw ho
s u ff e re d s e v e re h e m o rr h a g in g a t th e s ite w h e re a sh u n t fo r d ia ly s is h a d b e e n im p la n te d . W e q u o t e h e r e f

r o m Cheeks : In o rd e r to tes tify , D r. M y e rs, a fam ily p h y sic ian , m u st h a v e b e e n fa m ili a r w ith the st and ard of car e t o w hich a di al ysi s cl i nic, a nep hrol og i stand a radi ologi st a re h e ld
. McCaf

f r ey , 7 8 4 S o . 2 d at 2 0 3
. D r. M y e rs w a s n o t b o a rd c e rtified in f a mi l y pr a c t i c e o ra ny o the rs pe c i a l ty; was n ota membe ro f the A m er i can M e d ica l A ss o c iatio n ; w a s n o t o n sta ff a t an y h o sp ital a n d c o u ld n o t ad m it pat i ent s t o any hos pi t al ; had no s peci al tr ai ni ng orexper i ence i n the f i el d of nephr ol ogy; had neve rbe en i ns i de a di al ys i s c l i ni c i n M i s s i s s i ppi ; had neve r part i ci pat ed i n a di a l ys i s pr oc e du r e; had neve roper at ed a di al ys i s m achi ne; had n e v e r m o n ito re d a p a tien t w h ile h e w a s re c e iv in g the ac tu a l d ialy sis tre a tm e n t; re lied o n th e e x p e rtise o f a n e p h ro lo g ist w h e n d e ter m in in g w h e th e r o n e o f h is pat i ent s w as r ece i vi ng the appr opr i at e type of di al ys i s tr eatm entorr es pondi ng t o the tr eatm entas he shoul d; had neveri ns ert ed a gor t ex gr af t ; had neve rs een a g ra ft in se rte d in to a p a tien t; h a d n e v e r in se rte d a d ialy sis n e e d le in to a g ra ft; had neveri ns pect ed a gr af tw hi ch w as i m pl ant ed i n a pat i ent ; had neve r r ecomm ended thata gr af tbe r epl ace d; w as , by hi s ow n admi s s i on, not qual i f i ed t o r enderopi ni ons a s t o w hen orw hethera gr af ts houl d be r epl ace d, beca us e t hes e m edi cal opi ni ons f al l w i thi n a s peci al i zed a r ea i n w hi ch he ha d no exper i ence ortr ai ni ng; had neve rre ad any l i t er atur e on t he s peci f i c type of gr af tati s s ue; a nd di d notknow w ho m anuf actur ed the gr af

ti n ques t i on orthe

### 16

m anuf actur er' s r ecomm endat i on as t o the l i f e of the gr af t . D r . M yer s f

ur ther admi t t ed thati tw as the j ob of a r adi ol ogi s tt o det erm i ne w hethera part i cul ar g raft i s fun cti o n ing p rop erly; th at a rad iolog istinsp e c ted H en ry' s g raft appr oxi m at el y 30 days pr i ort o H enry' s death and f ound i tt o be oper at i ng pr op e r l y; a nd tha th e ( D r . M ye r s ) c ou l d f i nd n othi ng wr on g w i t h t hat ra d io lo g ist' s re p o rt. I d. ¶2 4
. S im il arly, D r. R aw li n g s w a s n o t q u a lified to te stify a g a in st D r. M c A u ley
. D r. R aw li n g s w as n o t bo ard ce rt if ied in o tolaryn g o log y or n eu ro-o tolaryn g o log y ; he w as b o ard
cert i f i ed i n neur os ur gery. H e l as tperf or m ed s ur gery i n D ece m ber1999. A tthe t i m e of T r oupe’ s s ur gery, D r . R aw l i ngs w as notact i vel y pra ct i ci ng m edi ci ne. D r . R aw l i ngs had no
s peci al tr a i ni ng ore xp e r i ence i n the f i el d of ot ol aryngol ogy orneur o- ot ol aryngol ogy. H e had
neverconduct ed mi ddl e ea rs ur gery, had neve rhad pr i vi l eges atan y ho spi t al t o conduct
m id d le e a r su rg e ry , an d w a s n o t q u a lified to c o n d u c t m id d le e a r s u rg e ry . D r. R a w lin g s d id
n o t h o ld h im se lf o u t to b e a n e x p e rt in o to lar y n g o lo g y o r n e u ro -o to lar y n g o lo g y . H is
curr i cul um vi t ae di d notdem ons tr at e any ar t i cl es t hathe had w r i t t en norany pr es ent at i ons thathe had gi ven r egar di ng ot ol aryngol ogy or neur o- ot ol aryngol ogy. Fur therm or e, T r oupe t ender ed D r . R aw l i ngs as an expe r ti n neu rosurgery . T rou p e’s c o u n sel rep ea tedly ask ed D r. R aw l i ngs abouthi s qual i f i cat i ons conce rni ng the ca r ot i d art ery. D r . M cA ul ey w as not
con du ct i ng surgery o n T roupe’s caroti d a rt ery ; he w as cond ucti ng surgery o n T roupe’s left
m i ddl e ear , as D r . R aw l i ngs admi t t ed. D r . R aw l i ngs r eadi l y admi t t ed thathe had ne ver per f or m ed mi ddl e ea rsur gery, beca us e he ne verhad pr i vi l eges t o per f or m m i ddl e ea r
s ur gery.

### Thus, in McL emo re , thi s Court aband on e d and

“ r e j e c t e d”thes t and ar d l a i d d own 13 

### in Frye v. Unit

ed St ate s , 29 3 F . 10 13 , 10 14 (D.C . Circ. 1 92 3). McL emo re , 863 So. 2d at 42 -43
. 17 ¶25. W e have cons i s t ent l y s t at ed thatw hen cons i der i ng M i s s . R
. E vi d. 702 i s s ues , our tr i al j udges ar e pl ace d i n the r ol e of gat ekee per s , “ens ur i ng t hatexper tt es t i m ony i s both r el evant
a n d re lia b le .” P o o le , 908 So. 2d at723 ( ci t i ng Kum ho T ir e Co. v. Car m i chael , 526 U
. S. 137, 1 4 7 , 1 1 9 S .C t. 1 1 6 7 , 1 1 7 4 , 1 4 3 L .E d .2 d 2 3 8 , 2 4 9 (1 9 9 9 ))
. See Mis s . T r ansp. Com m ’n v. McL em ore , 8 6 3 S o . 2 d 3 1 , 3 5 ( M i s s . 2 0 0 3 ) , wh e r e i n th i s Co u r ta d o p t e d th e ru l e l a i d d o wn i n D aub e r t

v. Me r r e l

l D ow P harm ac e uti c al

s, I nc . 509 U
. S. 579, 113 S. C t . 2786, 125 L
. E d. 2d 469 ( 1993)
. I n P o o le , w e l i kew i se r ei t erat ed t hat “[ t ] he rul e i s that the ex pertm ust 13
exer ci s e the s ame l evel of i nt el l ectual r i gorthatc har act er i zes the pr act i ce of an expe r ti n the
r el evantf

i el d. ” 908 So. 2d at724 ( ci t i ng McL em ore , 8 6 3 S o . 2 d at 37 -38 ). ¶26. W i th thi s i n m i nd , and i n r emem ber i ng the prof f er w hi ch w as bef

or e t he t r i al j udge
w hen he r ef

us ed t o a cce ptD r . Raw l i ngs ( a neur ol ogi s tw ho had neve rper f or m ed mi ddl e ea r
su rge ry), as an ex p ert t o o ffer an o p inion o n the a p p ro p ria te s tand ard o f ca re w h ich D r. M c A u ley (a n e u ro -o to lar y n g o lo g ist p e rfo rm in g m id d le e a r su rg e ry ) o w e d to h is p a tien t, C harl ean T r oupe, w e ar e unques t i onabl y compel l ed t o f i nd as a mat t erof

w el l
- es t abl i s hed l aw thatthe tr i al j udge di d nota bus e hi s di s cr et i on i n e xcl udi ng thi s opi ni on t es t i m ony on t he partof D r. R aw l i ng s. ¶27. T he pr act i cal ef

f ectof J udge G ar dner ’ s rul i ng a s t o D r . Raw l i ngs w as thatT r oupe w as undeni abl y l ef

tw i th the i nabi l i ty t o m eetherbur den of pr oof i n thi s m edi cal negl i gence cas e.

### 18

A gai n, “` [ i ] ti s ourgener al rul e thati n a medi cal m al pract i ce act i on negl i gence cannotbe
es t abl i s hed w i thoutm edi cal t es t i m ony thatthe def endantf ai l ed t o us e or di nary ski l l and
ca re.’ B ro o ks v. R o b e rts , 882 So. 2d 229, 232 (M i s s . 2004) ( ci t i ng S h e ffie ld v. G o o dw in , 740 So. 2d 854, 858 ( M i s s . 1999) )
. ” Cheeks , 908 So. 2d at120. W i thout expertm edi cal t es t i m ony, T r oupe w as unabl e t o carry herr equi r ed bur den of pr oof i n thi s m edi cal
m al pr act i ce c as e. ¶28. W e r ece nt l y once again d i scussed o ur sol em n res pons i bi l i ty i n r evi ew i ng a tr i al j u d g e ’ s g r a n to rd e n i a l o f a mo t i o n f

o ra d i r e c t e d v e r d i c t . I n c o n d u c t i n g s u c h a r e v i e w, we “m ustdecide w hetherthe fact s pres ented, t og et her w i th an y reasona b l e i nfer ences,
c o n sid e re d in th e lig h t m o st fa v o ra b le to the n o n m o v in g p a rty , p o in t so o v e rw h e lm in g ly in fa v o r o f t h e m o v a n t th a t r e a s o n a b le ju ro rs c o u ld n o t h a v e r e tu rn e d a v e rd ic t f o r t h e p la in tif

f.” R o b ley v. B lu e Cro ss

/B lu e S h ield , 935 So. 2d 990, 996 ( M i s s . 2006) ( ci t i ng D r ennan v. K r ogerCo. , 672 So. 2d 1168, 1170 ( M i s s . 1996) )
. T her ef or e, i n appl yi ng a de novo stan d ard of r evi ew as t o the tr i al j udge’ s gr antof a di r ect ed ver di cti n f

avo r of D r. M cA ul ey and N M M C , w e f

i nd thatthe tr i al j udge di d note rri n di r ect i ng a ve r di cti n f avor of t hese def endant s . C l ear l y, w i thoutthe t es t i m ony of D r . R aw l i ngs , w hen cons i der i ng al l t he evi den ce off

er ed dur i ng the pl ai nt i f f’ s cas e- i n- chi ef

, as w el l as al l r eas onabl e i nf er ence s
w hi ch coul d be dr aw n f r om the evi dence , a l l i n the l i ghtmostf avor abl e t o the pl ai nt i f

f , the pl ai nt i f f w as unabl e t o m ake outa pr i m a f aci e cas e s uf

f i ci entt o r equi r e the def

endant s t o go forw ard w ith their pro o f.

### 19

¶29. C ons i s t entw i th ourdi s cus s i on of t hi s i s s ue, w e r eac h t he i nes capa bl e conc l us i on that th is iss u e is w ith o u t m e rit. CO NC L US I ON ¶30. S ervi ng as the gatekeeper of R ule 70 2 op i nion t est i m on y, the t ri al j ud ge d i d n ot abu se hi s di s cr et i on i n di s al l ow i ng t he pl ai nt i f f’ s pr of f er ed t es t i m ony of

D r . R aw l i ngs as t o the ap p rop ri ate stan d ard o f ca re w h ich D r. M cA u ley o w ed to h is pa ti en t, C h arlean T rou p e. It
n e c e ss a rily fo llo w s th a t, c o n sis ten t w ith o u r ca se law , th e tri a l j u d g e li k e w ise d id n o t er r in gr ant i ng a di r ect ed ver di cti n f avorof the def endant s atthe cl os e of

the pl ai nt i f

f’ s cas e- i nch ief. ¶3 1. C ons i s t entw i t h t he di r ect ed ver di ct , t he t r i a l c ou r ts ub s e qu e nt l y e nt e r e d a f i na l j udgm entdi s m i s s i ng the pl ai nt i f f’ s c l ai m s a gai ns tthe def endant s . Forthe r eas ons s t at ed, t he L ee Count y C i r cui tC our t ’ s f i nal j udgmen ti n f

avorof D r . J ames M cA ul ey, N or th M i s s i s s i ppi M edi cal C ent er , I nc. , N or th M i s s i s s i ppi H eal th Servi ces , I nc. a nd N or th M i s s i s s i ppi Sur gi cal C ent er , I nc. , and aga i ns tC har l ean Tr oupe, i s af f i r m ed. ¶ 3 2
. AF F I RM ED . S M I T H , C .J ., W A L L E R , P .J ., E A S L E Y , D I C K I N S O N A N D R A N D O L P H , J J ., CO NCU R. DI AZ , P. J . , AND GR AVES, J . , DI SS ENT W I THO UT S EPARATE W RI TT EN OP I NI ON.